Health Care Contract & Rate Configuration Specialist

EmblemHealth, Inc.; New York (NY); Remote; USD 75,000 - 120,000; Full time

Job summary

EmblemHealth is seeking a Contract Configuration Analyst to load and maintain provider, facility, and ancillary contracts across all lines of business in a timely and accurate manner.

You will collaborate with Network Development, Analytics, and other teams to ensure proper translation of contractual agreements into the claims reimbursement workflow and to support ongoing rate reimbursement optimization.

Qualifications

• Bachelor's degree in Business Operations or equivalent required.
• 2–3 years of relevant healthcare experience required.
• Strong familiarity with EmblemHealth's claims systems and interdependent applications required.
• Experience in provider, facility, and ancillary contract files setup, maintenance, testing and auditing required.
• Experience translating contractual language into system reimbursement specifications required.
• Excellent knowledge of medical terminology, Fee Schedules, and ICD/CPT/HCPCS coding required.
• Understanding of Government reimbursement methodologies required.
• Analytical, problem solving, organizational and detail-oriented skills required.

Responsibilities

• Participate in all aspects of provider, facility, and ancillary rate configurations within deadlines with full accuracy.
• Collaborate with Network Management and Analytics to ensure proper capture of negotiated and modeled contracts.
• Identify and correct rate load problems.
• Assist with contract configuration, fee schedule/grouper and rate reimbursement matters.
• Analyze negotiated contracts to ensure reimbursement aligns with negotiated intent.
• Coordinate timely updates of evergreen contracts with Network Management.
• Recommend contract language changes to align with system reimbursement capabilities.
• Coordinate rate testing with BTS.

Skills

Analytical skills

Problem solving

Attention to detail

Healthcare industry knowledge

Contract language translation

Education

Bachelor's degree in Business Operations or equivalent

Master's degree (preferred)

Job description

EmblemHealth is seeking a Contract Configuration Analyst to load and maintain provider, facility, and ancillary contracts across all lines of business in a timely and accurate manner.

You will collaborate with Network Development, Analytics, and other teams to ensure proper translation of contractual agreements into the claims reimbursement workflow and to support ongoing rate reimbursement optimization.